Healthcare Provider Details

I. General information

NPI: 1508893520
Provider Name (Legal Business Name): RICHARD A HASS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

IV. Provider business mailing address

600 N COLLEGE AVE
GENESEO IL
61254-1091
US

V. Phone/Fax

Practice location:
  • Phone: 309-944-6431
  • Fax:
Mailing address:
  • Phone: 309-944-6431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209004738
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11038809
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: